Provider Demographics
NPI:1023078128
Name:LANGER, ROBERT D (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:LANGER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7559
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-7559
Mailing Address - Country:US
Mailing Address - Phone:619-993-4360
Mailing Address - Fax:877-596-6503
Practice Address - Street 1:555 E. BROADWAY
Practice Address - Street 2:SUITE 108
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-733-4452
Practice Address - Fax:877-596-6503
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39841207QA0505X
PAMD4273062083P0901X
WY7777A2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A49788Medicare UPIN